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A-METHAPRED SUMMARY

A-METHAPRED®Methylprednisolone Sodium Succinate for Injection, USP

Methylprednisolone Sodium Succinate, USP, an adrenocortical-like steroid, is the sodium succinate ester of methylprednisolone. It occurs as a white, or nearly white, odorless hygroscopic amorphous solid. Methylprednisolone sodium succinate is extremely soluble in water and is especially well suited for intravenous use in situations in which high blood levels of methylprednisolone are required rapidly.

When oral therapy is not feasible, and the strength, dosage form and route of administration of the drug reasonably lend the preparation to the treatment of the condition, A-METHAPRED (methylprednisolone sodium succinate) is indicated for intravenous or intramuscular use in the following conditions:

Endocrine disorders:

a. Primary or secondary adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice, synthetic analogs may be used in conjunction with mineralocorticoids where applicable; in infancy, mineralocorticoid supplementation is of particular importance).

b. Acute adrenocortical insufficiency (hydrocortisone or cortisone is the drug of choice; mineralocorticoid supplementation may be necessary, particularly when synthetic analogs are used).

c. Preoperatively and in the event of serious trauma or illness, in patients with known adrenal insufficiency or when adrenocortical reserve is doubtful.

d. Shock unresponsive to conventional therapy if adrenocortical insufficiency exists or is suspected.

e. Congenital adrenal hyperplasia.

f. Hypercalcemia associated with cancer.

g. Nonsuppurative thyroiditis.

Rheumatic disorders — As adjunctive therapy for short-term administration (to tide the patient over an acute episode or exacerbation) in:

Clinical Trials Related to A-Methapred (Methylprednisolone)

Nanocort in Acute Exacerbation of Relapsing-Remitting Multiple Sclerosis (MS) [Recruiting]
Patients with an acute exacerbation of Relapsing-Remitting Multiple Sclerosis or with
Clinically Isolated Syndrome receive either one single infusion of Nanocort or three daily
infusions of SoluMedrol. Main objective is to assess the occurrence of new
gadolinium-enhanced T1-weighted lesions at week 8 vs week 1 after treatment.

Purpose of Study: This study will purposefully study a population equivalent to the placebo
group of typical trials in SLE. Patients will enter the trial in mild-moderate flare, be
treated with depomedrol, and background treatments will be withdrawn. Biomarkers at entry on
various medications will be compared to biomarkers after steroid efficacy with background
medications withdrawn. Depomedrol usually slowly wears off over one to three months.
Patients will be closely observed, with serial biomarkers drawn at monthly intervals or,
immediately at the time of a new flare. Those patients who do develop new flares during the
course of the next year (maximal participation time) will donate blood samples for
biomarkers (flaring on tapering or absent depomedrol effect) and will then be immediately
treated as deemed appropriate, exiting the study. The study will end when 50 patients have
met this endpoint. A control population of matched, healthy individuals will donate blood
once for the same biomarker studies.

High-Dose Methylprednisolone and Rituximab in High Risk B-CLL [Recruiting]
Studies have shown that both high-dose Methylprednisolone and Rituximab used as single agents
are effective in relapsed and refractory B-CLL. Methylprednisolone acts independently of p53
apoptosis pathway. The combination of both drugs may improve response and outcome in
previously treated high-risk B-CLL patients.

Study Objectives

Primary:

To determine the clinical benefit of high-dose Methylprednisolone and Rituximab in previously
treated high-risk B-CLL patients in terms of clinical and flowcytometric response rate.

Secondary:

To determine progression free and overall survival. To characterize the safety profile of
high-dose Methylprednisolone and Rituximab.

Methylprednisolone N Acetylcysteine in Hepatic Resections [Recruiting]
This is a prospective double-blind randomized phase II clinical trial, with two groups of
intervention (one with administration of N-acetylcysteine and the other with administration
of methylprednisolone), and one group of placebo. The purpose of this study is to
investigate the role of N-acetylcysteine and Methylprednisolone in the modulation of warm
ischemia of the liver during hepatic resection. In fact to avoid massive blood loss in liver
surgery, continuous or intermittent vascular clamping of the hepatic hilum ('Pringle
maneuver') is generally used with good results. However, as a consequence, ischemia and
subsequent reperfusion result in complex metabolic, immunological, and microvascular
changes, which together might contribute to hepatocellular damage and dysfunction. This
phenomenon, known as ischemia-reperfusion (IR) injury of the liver, is a complex multi-path
process leading to the activation of some inflammatory pathways. Any patient candidate to
liver resection will be enrolled in the study based on the aforementioned criteria. The
primary objective of the study is to assess the real efficacy of Methylprednisolone and
N-acetylcysteine in reducing the secondary damage from ischemia reperfusion injury in liver
resection and in reducing inflammatory response. Secondary objective of the study is whether
the reduction of ischemia-reperfusion injury results in: lower incidence of postoperative
liver failure, improvement of postoperative liver function, and reduction of blood
components transfusions. The randomization will be done the day before the operation. The
drugs will be prepared in a blind fashion by the hospital pharmacy. The hospital pharmacy
will provide to each patient a drip to make bolus of about an hour before the start of the
liver resection and a syringe pump for an infusion of approximately 6 hours. If the patient
is enrolled and randomized in the placebo arm, he/she will receive 250 ml of glucose 5%
plus the infusion of 100 ml of glucose 5% If the patient is randomized in the
Methylprednisolone arm, he/she will receive a dose of 500 mg in 250 ml of glucose 5% plus
100 mg of glucose 5%. If the patient is randomized in the N-acetylcysteine arm, he/she will
receive a dose of 150 mg/kg in 250 ml of glucose 5% plus N-acetylcysteine 50 mg/kg in 100 ml
glucose 5%. Systematic sampling of liver function tests will be done the day before the
operation, at the end of the operation, as well as in postoperative day 1, 3, 5 and 7.